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..-''"'....,. m C';'-,,;;)1 ("') (/J Z oC.:...",::) rrl ;JO n ~ "- co 0 --.j 0 m ~ ;:'1,~!" c::: l> "'T1 (f) --.j f',.) :D c: ! ::::0 ~, "- rq :z m n --i rTl CJ ~~ Z """1 ,a., I --0 a (1 '" ~-)...f-: -< 0 :x:- l: ~ 0 ., 0 -." C) en N ~ c..... . ~. -+ rn - \ co -rl lSl ~" ..~ ("\ (,I) N ."IIi~ co Z lSl '" l\ In '" ::J: c::;J ':r: Pl CJ) 00 rrj ~.J'. "- en ~ ~ ., -C !"> C) -I lSl fT) :::3 r ::D :0 -.....J -CJ CJ r ,;::..",. -J C -.....J (j) ~ 01 s: N ~ f-> :;0<; -J IT! +:>- ,.- l> N ~ -.<:.. G:l .................. r'b CD (j) .,..r:; Z ~ Ul 0 AFFIDAVIT OF MARITAL STATUS STATE OF NEBRASKA ) ) ss. COUNTY OF HALL ) /.< ,~o COMES NOW, the undersigned, being first duly sworn upon oath, and deposes and states that the undersigned knows the Decedent and the surviving spouse ofthe Decedent and that the following information is true and correct. 1. Name of Decedent: Richard Joseph Mohanna Date of Death: March 8, 2007 Domicile at Death: Cairo, Hall County, Nebraska Name of Surviving Spouse: Alta Jean Mohanna Date of Marriage: October 1, 1949 2. The Affiant is the son of the Decedent and, in that capacity, is familiar with the marital status and the death of the Decedent. 3. That there is no federal estate tax, Nebraska inheritance tax or Nebraska estate tax due. 4. Title to the following described real estate is held by the Decedent and the surviving spouse in joint tenancy, to-wit: Lot Seven (7) and the North Half (N1/2) of Lot Eight (8), Block Five (5) in the Village of Cairo, Hall County, Nebraska. The South Half (S 1/2) of the East Twenty Feet (E20') of Lot Five (5), and the West 125 feet of Lot Four (4), except the North 107 feet of the West 125 feet of Lot Four (4), Block One (1), Ingalls Turner Subdivision to the Village of Cairo, Hall County, Nebraska. 5. As of the date of death, the real estate had a fair market value of $86,386.00, and $117,885 respectively. 6. The Decedent and the surviving spouse were married as of the date of death. There is no Nebraska inheritance tax lien by reason of Nebraska Revised Statute FJ77- 2003. There is no Nebraska estate tax lien by reason of Nebraska Revised Statute FJ77- 2102. FURTHER Affiant saith not. ! ...".....'~ .. ..~'~,~" -~...,. f/Ld~-c/ Subscribed and sworn to before me this .:< 7 day of August, 2008. (/.... /) ~ (j MJe otary Public GENERAl NOTARY. State of Nebraska DENISE D. MYERS My Comm. Exp. Nov. 20, 2010